Healthcare Provider Details

I. General information

NPI: 1225181100
Provider Name (Legal Business Name): INTRACARE INFUSION AND COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 CALLE CESAR GONZALEZ
SAN JUAN PR
00918-2637
US

IV. Provider business mailing address

479 CALLE CESAR GONZALEZ
SAN JUAN PR
00918-2637
US

V. Phone/Fax

Practice location:
  • Phone: 787-250-1515
  • Fax: 787-753-0708
Mailing address:
  • Phone: 787-250-1515
  • Fax: 787-753-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number08F2456
License Number StatePR

VIII. Authorized Official

Name: ANIBAL LUGO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 787-250-1515